Author: Marc

Obviously the impact of lockdown and social distancing has been serious for many of my readers, and I’ve struggled to think of what I could share that might help. Finally I think I’ve got something to say. Even as the world closes down around you, you have to stay open!

In my last scientific article on addiction and recovery, I set out a new and improved model of addiction (described in more detail here). I looked at addiction as a “narrowing” of the brain — a setting and solidification of neural networks focused on drug rewards — paralleled by a narrowing of the (available, meaningful) social environment.

This is not rocket science, or even brain science.

The main trouble with the “brain disease model” of addiction is that it ignores the massive impacts of the social environment. Yet we know that emotional challenges create the predisposition to later addiction. We know that the social environment (including one’s family history) matters hugely. We know that abuse (including emotional abuse) and neglect during our growing-up years are by far the best predictors of addiction in adulthood. The brain disease model simply can’t make sense of these facts. How could a brain disease develop from hard times growing up?

So in my model I emphasize that harmful social experiences have a shrinking or narrowing effect. If caregivers or peers make you feel off or wrong or insecure, or unable to trust, unable to just be, then you ingest what gives you the next best thing. Something that soothes you and defines you. And then, as time goes by, you connect with people more shallowly, you connect with fewer people, you connect with fewer people who might actually love you — family, friends, lovers. That’s the outer garment of addiction: the thinning, the contraction, of the social world. And it parallels the “contraction” of available neural networks in the addict’s brain.

The social shutdown isn’t just in the words and deeds you receive from people you know. It’s also a reduction in the places you go, activities, walks in the park, the freedom to be buffeted by babbling crowds shopping, living, watching, listening. When drink or drugs seem all that’s available to provide what you need, you let go of other possible sources of pleasure and satisfaction, energy, and identity. They were never that reliable to begin with. And before long you forget about them, you forget how to find them, you forget they even exist. That’s what locks addiction in place.

It’s what Johann Hari wrote about in Chasing the Scream: the opposite of addiction isn’t sobriety; it’s connection.

So living through this pandemic, here’s the main problem. The impact of social distancing on many people is increased loneliness, greater contraction of the social world, an accelerated plunge into being by yourself. For people with addictions, that’s the opposite of what they need most, the opposite of what they need in order to forget about getting high, at least for awhile.

Maybe it’s obvious, but it’s also what I’ve been told by my psychotherapy clients, especially those who haven’t quite found their way back to a drug-free (or drug-reduced) existence. The four walls feel more like concrete barriers than dividers in a lively hive. The doors and windows start to feel like relics of an existence that’s no longer possible. You can’t go out, you can’t mix, you can’t meet up, except online. And that’s just not quite the same. All you’ve got left is your addiction…or so it seems.

For those who are taking care of kids who are also stuck at home, the increased contraction of possibilities is laced with stress. You have to attend to these little buggers all day long. You love them, okay, but they’re kids. They’re not there for you. You’re there for them. So, infused in your isolation are the toxic currents of stress, not only boredom but frustration and anger and a sense of inadequacy. All of which derive from the situation, but it feels like they derive from you, from your own shortcomings. There you are, trapped inside your bunker, with heightened demands and anxieties that would be hard enough to deal with if you were free to get out and mix with other parents and relatives and the world at large. Forced captivity with junior cell-mates is nothing like being free to wander and connect.

So here’s what you should do. If you’re trying to quit or control substance use (or other addictive activities — porn, online gambling, whatever), get your ass out of the house! Social distancing doesn’t mean solitary confinement. Here in my city in the Netherlands, I’ve seen more and more people strolling over the last two or three weeks. People walk, and when they’re about to pass by, either they or you or most likely both of you move aside, so there’s a good two meters (six feet) separation. That separation doesn’t prevent, in fact it seems to enhance, people’s tendency to smile at each other, say Hi, wave, even utter a few words of greeting.

And it’s springtime! (at least in the northern hemisphere) The bushes and trees are budding and leafing like crazy, the flowers are coming out. My mood improves about 300% after I’ve walked around for awhile. And when you get home, call or zoom someone you care about. Ask about them. They’ll ask about you too. It’s easy to imagine that our isolation is some kind of penance for imagined wrongdoings. It’s not! The world is still full of people. And you still have an instinctive need to connect with them, in whatever way you can.

Getting out of your home is going to make you feel like you’re a part of the world rather than a prisoner on Rikers Island. And that’s going to help you feel like you don’t need to get loaded, or maybe have two drinks instead of eight, or maybe watch a movie, read a book, and fall asleep gently, wondering about the mysterious mix of chance and destiny that’s landed us in this crazy time. Together.

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At the heart of the discussion about addiction and recovery lies a trilogy of questions: whether abstinence is necessary or even helpful, what “harm reduction” offers in its place, and what is the best way to deal with cravings. These questions are intertwined. In fact they merge into a single issue. Today I want to approach this issue from the perspective of part-selves, and look more closely at harm versus care.

You probably know the parts better than you think. My addict self comes out of nowhere and roars into life. She’s incredibly determined, so I end up giving in before I even know it. Twelve-steppers say she’s doing push-ups in the parking lot. That part seems so evidently not-self, and yet it obviously is a part of the self. Or: I give myself such shit the morning after. You’re just a fucking loser, addict, drunk. You don’t deserve sympathy. You don’t even deserve to be alive! Again, that voice comes at us, so it feels like not-self, yet it obviously is a part of the self as well. Who else could it be?

Those are “parts” we recognize most easily. But according to IFS, Internal Family Systems therapy, there can be many more parts to us. I wanted to be at an IFS workshop this week. I’d paid the fee, bought my ticket to Bristol, reserved an Airbnb, cleared my calendar. And then the coronavirus came along and dashed my plans, as it has obliterated plans, wishes, normalcy, for so many of us. So I won’t write about IFS today. I don’t understand it well enough yet. But I already practice a kind of psychotherapy that recognizes “parts” — so I feel an intuitive connection with this approach, and my reading on IFS continues to flesh it out. More on IFS later.

For now, here’s my take on the parts:

Clearly craving is the single biggest challenge to people who want to overcome their addiction. The recommended methods to deal with cravings are (1) urge surfing — watching the craving come, peak, and then dissipate, while maintaining a mindful objectivity, and (2) developing new thought patterns, usually with the help of others, that result in abstinence until the cravings subside over time (or, less optimally, “white-knuckling” until you can start to relax). If these work for you (or your friend, family member, client) then that’s just great. And sometimes, when the consequences of substance use are dire and immediate, abstinence may be the only sensible choice.

But abstinence has a huge drawback. It’s incredibly difficult! It can feel like turning your back on your best friend, on love and comfort, forever! It can feel like kissing goodbye to the one thing in your life you could control — changing how you feel. It can leave you staring into an existential void, facing an abyss of emptiness and meaninglessness. So, abstinence very often leads to “relapse.” We know this story well, and it provides a (false) rationale for defining addiction as a chronic disease.

Abstinence erects a steel fence around the part of us that wants and feels it needs to get high (or get full, in eating disorders). But what if we were to take that part and, instead of turning our back on it, telling it “No, never again!” what if we were to embrace that part, listen to it, and comfort it. What if, instead of banishing the needy part, we were to get to know it, maybe even get to love it, so that it doesn’t have to feel so walled off, shunned and hated.

The logic is simple: as long as we wall off this part of us, it not only continues to exist, it gets more desperate and determined. Now it has to weaponize and force its way through. In psychodynamic parlance, the more you suppress a powerful urge, the stronger (or more devious) it becomes.

So, instead of banishing that part, in IFS and other psychodynamically-oriented approaches (including ACT and my own cobbled-together approach), the idea is to listen to the craving and connect with it. Can there be value in this?

It’s such an outlandish idea in many people’s minds, that I’m not at all sure this approach gets tested very often. (Research on IFS is still in its early stages.) But I’ve seen it work with some of my clients. And obviously I’m still developing the relevant skills.

Little kids crave what they can’t have, and the cookie jar doesn’t lose its appeal by being placed out of reach. So we give the little kid something else to eat, maybe a piece of fruit or cheese (think methadone). And/or we create a bridge to the treasured outcome. We say, you can certainly have a cookie, in fact two cookies, when it’s dessert time. That’s after dinner, at 6:30. Do you think you can wait that long? Let me help you. Let’s get busy doing something else.

Connecting with cravings doesn’t mean you have to be stupid about it, run out of your apartment and score as much coke as you can snort. In fact, being smart about cravings is one way to hold and soothe the part-self that feels so needy.

But the benefit of accepting and embracing the needy part isn’t just scaffolding it and keeping it from tearing the house down. Its greatest benefit is the feeling of integration you foster in yourself. The craving part is young and wild, defiant, and very much alone. But it’s a part of you! Finding out where it comes from — in your growing up years, in your efforts to control troubling emotions, in your battles against depression and anxiety — allows it to relax and connect with the rest of you. This opens the door to self-acceptance and self-love, which often seem so elusive in addiction.

And when the need is no longer desperate and isolated, that’s when you can manage to count your drinks, call a friend, watch a movie instead, shift from whiskey to wine (my target these days — I’m down to one scotch and a glass of wine most nights) …and taper, gradually — develop a schedule of controlled use or stop entirely. Once you feel less fragmented, once the warring factions have laid down their arms, you might find that place much more accessible, and it’s a lot less likely to give way when life throws its next curve-ball…or its next virus.

To me, this is harm reduction. Specifically, a psychological approach to harm reduction that makes sense and feels right.

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The coronavirus pandemic reminds us not only of the proximity of death (and other fun stuff) but of the contradictions we face throughout our lives. Some of which seem truly unsolvable. Here’s one that’s had me chasing my tail for awhile:

How should we address ourselves with compassion and love when in fact, according to the Buddhists (and according to neuroscience), selves don’t actually exist. The self is an illusion, says the Buddha, and I have a hunch he’s right. What has any of this to do with addiction and recovery? You’ll see.

(I’ll get to the neuroscience view of the self another time. Just wanted to throw it in as a teaser for now.)

Trapped in the living room

For the last four days my family and I have been camping out at home. On Tuesday, my wife Isabel told her grad students and colleagues that she’d meet them via Skype of Zoom. She said group meetings at the university weren’t safe. They thought she was nuts. Over-reacting. How many times having have you heard that term this week? On Wednesday, she decided to keep our boys (almost-14-year-old twins) home from school, and left me to explain to the school authorities that, no, Ruben and Julian don’t appear to be sick at all. We’re just being cautious. Um, you can’t really do that, they said. The law is that children must be in school. But growth curves show no mercy. On Thursday, the university announced that large classes were cancelled, were shifting to online lectures. On Friday, the university announced that it was closing completely. And the boys’ school sent out an urgent email: keep your kids at home. No more school this week. Not much joy in saying I told you so. We figure that here in the Netherlands we’re about a week behind Italy (a close neighbour) and quickly approaching the UK scenario.

Our boys have been studying, reviewing, forging ahead with new chapters in schoolbooks whose names I no longer feel I need to know how to pronounce. They earn an hour of screen time for every two hours of studying. So…not a total loss in their view. Sometimes it’s eerily quiet in the living room, while four medium-to-large-sized mammals sit and whisper to themselves, until the sounds of clashing swords tear through the silence. No, not the long-awaited Gen-Z rebellion. Just somebody’s headphones coming off during a video game. And I watch Alexios, Julian’s ruggedly good-looking ancient Greek mercenary, try yet again to defeat Medusa and her guards. That’s father-son bonding, right? — justifiably my homework. I love it.

We Dutch (we’re actually Canadians, still searching for an identity) are known for our confidence, everything under control, we know how to deal with floods and such. And we’re super industrious and smart, highly skilled at cooperation. In fact this has evolved into an almost animal instinct to follow rules — all rules, any rules (e.g., the rule that kids must be in school unless they’re really sick, even during a pandemic).

How to torture the Dutch

Want to know how to torture a Dutch person? (I say this with real affection, and  just a bit of mockery. I’m allowed…after living here for nine years). When there is absolutely no traffic, anywhere, in any lane, as far as the eye can see, you cross the street, EVEN THOUGH THE LIGHT IS RED. (This can be done either on a bike or on your feet. It works best when it’s raining, which is pretty much always.) Halfway or more across, gaze back at the people still huddled on the sidewalk. Look at their faces, twisted in the agony of, not only indecision but true existential paralysis, a sense of doubt (that extends back to the Big Bang and covers everything up to this morning). They see you crossing, they want to cross, they wish they could cross, but the light’s red. Their expressions reveal horror, confusion, contempt, envy, and most of all shock. Because there it is: the fundamental impossible-ness of life — the paradox that can’t be mended, the incompatibility of two totally logical, obvious, unarguable truths. The epitome of unsolvability. (see above) And you know, some of them will cross and others won’t, and regardless, in both sets of people, you can detect the early signs of mental breakdown. I’m no Buddhist scholar but some of the stuff I’ve read, like Robert Wright’s “Why Buddhism is True” and Sam Harris’s “Waking Up,” suggests that the Buddha might have been deliberately trying to get you to have a mental breakdown anyway.

The point

Here’s another paradox, a logical polarization, that could drive you as crazy as the Dutch people on the sidewalk facing freedom directly, right now, but longing for a green light regardless.

What’s the worst that can happen, coronavirus-wise? It’s obvious: you can die. Or perhaps worse, one or more of the people you love can die. So, there’s death. And we’re all going to die anyway. So, is death really such a big deal? According to Buddhism, and as expressed so starkly by the authors I mentioned, the problem with death is that we are attached to the illusion of having a self. When you get right down to it, the self just isn’t real. The stuff going on inside you and the stuff going on outside you is all just stuff going on. (I realize this is a truly inadequate summary of the main tenets of Buddhism. I’m no Buddhist scholar, as mentioned, so why pretend.) True, consciousness seems to illuminate the stuff going on inside you and around you in a particular way, but the idea that you own this stuff, the idea that it’s special, that you’re special, is just a convenience that we stumble upon some time in the first year or two of life (and that gets reinforced by some ill-conceived strains of parenting, perhaps designed to foster life-long anxiety. I mean, being the centre of the universe has got to be hard to keep up).

So let’s say the Buddhists are right and there really is no self. I believe this to be true. And yet: I have advised many clients (and other people) and myself (frequently in fact) to talk to oneself (Notice that words containing “self” reappear annoyingly often.) In particular, if you’re depressed or feeling empty, or a dark, anxious state is settling over you, as is often the case AFTER (or during, or even before) a period of addiction, then one of the most helpful things you can do is talk to yourself, either out loud or in your head, in a friendly way. This corresponds to “self-compassion,” which is all over the Net these days, which I sometimes discuss on this blog, and which is one of the driving principles of “lovingkindness” meditation: you start by loving yourself, and that makes it easier to love others. Addicts are notorious for self-hatred. We’ve discussed the reasons why over many previous posts. I see it as a key goal of addiction psychotherapy to get rid of this self-hatred before it gets rid of you.

I often advise people specifically to say things like “Good morning Jo (one’s own name). Hey, how’s it going? Not so great? Don’t worry. You’re not a bad person. Even if you slipped up last night, even if the label “addict” still hangs in the air, you’re not some despicable reptile. You’re just trying to hurt less. Self-blame and self-hatred simply aren’t appropriate. You didn’t ask to have the life you’ve had, to be exposed to that kind of pain and then discover an escape route, and you’ve been doing your best to get it under control — and succeeding! When you switch to first-person and say these friendly, nurturing things to yourself, it sounds like, “I’m okay…I really am trying…I’m not bad” and then you start to feel different. Whether you pitch this conversation in terms of a you or in terms of an I, there’s an explicit assumption that there’s a self, a self that you are trying to accept, comfort, nurture, and love.

But what if the self is an illusion? Maybe something like that tortuous stoplight? How would we make sense of this paradox?

Here are three approaches:

1. Tonight I had dinner with a good friend and his 15-year-old daughter, Bo. When I revealed my conceptual conundrum at dinner (Pieter is a philosopher, so this would be acceptable table talk) Bo said: If there’s no self, just a bunch of thoughts, then don’t try to be nice to your self. Just be nice to your thoughts. (Brilliant, don’t you think?)
2. Saying to yourself that you really are a good self, and you shouldn’t carry around this load of self-blame and so forth, is absolutely the right thing to do. Because, first, it works: it makes you feel happier, lighter, more open, less depressed. And second, talking to your “self” this way doesn’t mean there has to be a real self in operation. The reason it works, the only reason it works, may be that it dilutes or refutes the conviction that you are a BAD self. Not even that you have a bad self; that you are a bad self. Getting rid of that just brings you back to neutral, back to zero, which seems approximately where the Buddha wanted you to end up. Not so you could just be dull and blank and detached, but because “neutral” in this sense is an open gate, or maybe, better yet, a roundabout…from where you can move in any direction.
3. Here’s an extension of #2. You probably do blame your “self” for all the shit you’ve done, all the trouble you’ve gotten into, all the hurt you’ve caused others AND yourself. Not only from being an addict, but probably from well before that started, when the lesson filling the blackboard in the kitchen was that there is indeed a you, who happens to be selfish, and greedy, and envious, and probably many other not-nice characteristics, like mean and manipulative. (What kid isn’t manipulative?) That’s a lot of badness to have to face every day of your life. Certainly no advantage when you’re trying to stop drinking or snorting stuff. And wouldn’t it be something if this flawed and fantasized vessel, the self, just happened to be the most effective means for packing guilt and shame — hence anxiety and depression — into your sense of being alive. So, being nice to yourself, being friendly to yourself, might already be accomplishing something fabulous, even if the self was always just an illusion: using one side of the illusion to dispel the other.

So, talking to your “self” in a friendly and comforting way simply diminishes the enormous weight you carry around, consisting of the sense of having a very big, very central self, who’s defining characteristics are really quite unpleasant, even ugly and revolting. In other words, maybe, if the metaphor works, when there are no cars coming, when you’re really not in any danger, then don’t worry whether the light is red, or green, or even real. That’s no longer the issue.

And here’s a little secret that I think fits just about perfectly with the thrust of ACT, which was the topic of last week’s post. If the light remains red for a very long stretch of time, and there really are no cars coming or going, then the light is probably broken. That could be an ideal time to see if you can approach things in a completely different way.

 

Last post I said I’d review schools of psychotherapy that promise to target addiction, and ACT and IFS were at the top of my list. I’ll get to these, but I thought I’d spread the net a bit wider. So I’m starting this series with a look at “psychodynamic” or psychoanalytic psychotherapy. I think the underlying concepts of this tradition are crucial for understanding and overcoming addiction.

Psychoanalysis (think Freud and his followers) is the mother of all psychotherapies. No matter what you’ve heard, no matter how much people scoff at penis envy and other outdated concepts, Freud was a genius. He was the first (as far as I know) to develop a “talking cure” for serious emotional difficulties, and he was the first to bring the idea of unconscious wishes and motives into public parlance. Sure, psychoanalysis — on the couch, four times a week, for fifteen years (?!) — hasn’t lived up to expectations, and I believe it’s correctly pushed aside by more focused, present-tense-oriented, and evidence-based treatment models.

But its offspring, psychodynamic psychology, isn’t so easily ignored. So my goal for this post is to tell you how this approach tends to frame addiction and how it can help, directly or indirectly.

The person who first comes to mind (and to Google) when you put “psychoanalytic” and “addiction” in the same search is Lance Dodes. His 2015 book “The Sober Truth” purports to debunk 12-step methods as riding on bad science. I have mixed feelings about this book. If “Science” with a capital S is to be our lodestone, then psychoanalysis doesn’t look so hot either. But, okay, Dodes is inspiring, he’s developed his methods over decades, he’s come down strongly on “resort” rehabs (great video!) like those spawning in Malibu, California. So I want to touch on his perspective.

This is how Dodes conceptualizes addiction, and it captures core features of the psychodynamic insight:

“[E]very addictive act is preceded by a feeling of helplessness or powerlessness (an overwhelming of the capacity to manage [one’s moods or feelings] without feeling emotionally flooded). Addictive behavior functions to repair this underlying feeling of helplessness. It is able to do this because taking the addictive action (or even deciding to take this action) creates a sense of being empowered, of regaining control over one’s emotional experience and one’s life. This reversal of helplessness may be described as the psychological purpose of addiction.”

Of course we know that this temporary “empowerment” leads to further helplessness, but the initial rush of self-determination is not to be denied. More broadly, psychodynamic approaches always look at present problems in the light of one’s early development. A realistic and increasingly popular spin-off of this position is the emphasis on childhood trauma, most famously highlighted by Gabor Maté, as featured in this clip. Whether a specific trauma is discovered or not, psychodynamic psychotherapy works to get people to rediscover and reinterpret their early struggles. The assumption is that addiction is an ineffective resolution to conflicts and defeats that were never fully accepted or resolved.

There are addiction treatment centres (e.g., Caron Treatment Centers) that expressly tap psychodynamic psychology in their approach. Other organizations combine aspects of psychodynamic psychology with other traditions. Andrew Tatarsky’s Center for Optimal Living in New York offers a harm-reduction approach that has psychodynamic psychology (and thus individual psychotherapy) built into it. I particularly like Tatarsky’s model (I spoke there and met him last June) because it is fundamentally empathic and humanistic, honouring individual differences and working with them.

What’s most interesting to me is how psychodynamic ideas provide a foundation underlying many current schools of psychotherapy. With respect to addiction, ACT and IFS (my favourites — see last post) are all about bringing the past into the present and dealing with it. What seems to be missing from our lives? When did that start? Where does the depression come from? What messages do we repeatedly give ourselves that make us feel hopeless or despicable, so there seems little opportunity for relief except our addiction? Where do contradictory self-statements, like yes, this is what I want and I hate doing this! actually come from?

My own training in psychotherapy was entirely psychodynamic. I learned and practiced with children and adolescents, and my mentors were pretty classical by today’s standards. But what I do now, and what I think most psychotherapists do, is blend different approaches, revising and refining our methods until we find what works best. And what works best appears at the interface of our own personality and knowledge base, our style of connecting with others, and the particular problems (in my case, mostly addiction) that come our way.

The problem with “pure” psychodynamic therapy is that it spends too long reinterpreting past events without connecting them intimately and acutely with current issues. As a result, pure psychodynamic therapy can take too long and never really get to the here-and-now. Yet the here-and-now mustn’t be put off when it comes to addiction. Addiction is self-perpetuating and it involves synaptic changes. Psychodynamic therapy ignores the fact that deep habits are neurally encoded and their momentum doesn’t derive from…any one thing. What’s more, people with addictions are truly miserable. They may live their lives on the cliff edge of self-destruction. So, for me, the psychodynamic approach works best as a platform on which to devise and enrich more direct interventions. Yes, we have to understand where we come from, but mostly as a means for understanding where we’re at now and where we’re going next.

 

 

 

 

 

 

 

In my psychotherapy (and chats, consultations, etc) with people in addiction, I combine skills I’ve picked up over 35 years studying clinical psychology, developmental psychology, psychoanalysis, and neuroscience. But it’s not enough. I need retooling.

I’ve developed some good intuitions about how to do psychotherapy…mostly by doing it, putting theory into practice. And I can be effective with people in addiction partly because I’ve been there myself. I know I’ve helped people transform their addictive habits. I’ve had clients who’ve quit, cut down substantially, or who continue to use or drink without a sense of desperation or compulsion. I’ve helped people discover or rediscover how to like themselves, forgive themselves, even love themselves, sometimes despite vast challenges (including abuse of one kind or another) during childhood and/or adolescence. And I’ve helped people devise cognitive tricks to shunt their trajectory away from substance use and toward more satisfying habits.

But I’ve failed a lot too. I’ve had clients I haven’t been able to help, for whom my best instincts amount to little more than a shot in the dark. With drug addiction, every failure is potentially lethal. So I figure I need to retool.

So what’s the best way to do that?

Like so many other “experts” working with people in addiction, I’m still looking for the silver bullet. Or bullets — because I can name ten schools of psychology, psychotherapy and mindfulness training off the top of my head (and some pharmaceutical approaches as well) — most of which aim to help people recover from addiction (as well as other mental health goals). And most of them do help. Some people. Sometimes.

But there seems to be a black hole in the centre of the addiction galaxy that sucks in techniques of every sort and laughingly squishes them to nothing, tosses them back down some wormhole to some parallel universe. And surely that’s because addiction boils down to a unique “thing” which is totally psychological, totally biological, and totally social. A habit in the workings of our cells, our minds, and our interpersonal relations.

(And by the way, when people ask whether addiction is psychological OR biological OR social, they’re asking the wrong question.)

But besides that, the very unique thing about addiction is that when you start to beat it, when you actually start to succeed in your recovery, then instead of a radiant glow of achievement and satisfaction (that may come later) you’re often left with an aching emptiness. And what the hell are we humans supposed to do with that?! (Mindfulness/meditation has some answers, but let’s face it, the solution isn’t obvious.)

So, I want to spend the next few posts examining some of the therapeutic techniques that are potentially effective with addiction, and try to figure out what works best, what works for whom, and how we might nudge some of these techniques so they’ll work even better. I also want to address this issue of “emptiness” head-on. It’s a biggie.

I’ll start by sharing my own plans for retooling.

Acceptance & Commitment Therapy (ACT)

ACT combines techniques from cognitive-behavioural therapy (CBT) with techniques from mindfulness/meditation. It’s oriented toward people’s basic deep-down needs — and the incredible things they do to avoid them, deny them, or satisfy them in ways that just don’t work. It’s also strategic, in that the therapist serves as a coach to try different approaches to recurring negative experiences. ACT is explicitly geared toward conscious change in how we interact with ourselves and with others.

I’ve used some ACT themes in my own work with clients. They help. But I want to get to the details. So I’ve recently enrolled in an online intensive training course. The course is taught by Steven Hayes, the founder, a guy who somehow resembles a martian, totally bald, with sea-shell ears that rise at an odd angle, but who radiates wisdom, compassion and skill. ACT is partly devised to help people with addictions. And other addiction workers (like Matt and Peter Sheath who’ve posted on this blog) see it as effective. So what’s the secret? I’ll tell you what I’m learning as I learn more.

Internal Family Systems (IFS)

IFS is a school of psychotherapy that identifies and listens to the internal voices in our heads — most obvious in addiction through the (sometimes horrendous) conversations or shouting matches between the taking-care self, the addict self, and the internal critic (how they’re often recognized and identified). The founder, a guy named Richard Schwartz, studied family systems therapy back in the 70s and began to realize that all the shit that goes on between family members is actually going on in our own heads. Sometimes almost constantly.

IFS is well-designed for dealing with addiction because addicts so frequently say “there’s a part of me that just says fuck it, I want to use” and ignores the arguments of other “parts” of the self. This division of one part of oneself from other parts just begs to be dealt with head-on. I sometimes focus on clients’ internal dialogue in my own therapy practice, though I’ve never studied IFS seriously. But now I’m reading up on IFS…to get ready. I’ll be attending a 5-day intensive workshop on IFS for people in addiction this March. I’ll let you know what I learn.

I hope visits to these and other psychotherapeutic approaches will be useful for readers who are devoted to helping people in addiction. But I also think they’ll be important for those who are struggling with their own addiction — because they can highlight what’s available from different forms of therapy and introduce powerful techniques you can use on your own.